Telehealth system (e-CUIDATE) to improve quality of life in breast cancer survivors: rationale and study protocol for a randomized clinical trial.

BACKGROUND Breast cancer survivors suffer physical impairment after oncology treatment. This impairment reduces quality of life (QoL) and increase the prevalence of handicaps associated to unhealthy lifestyle (for example, decreased aerobic capacity and strength, weight gain, and fatigue). Recent work has shown that exercise adapted to individual characteristics of patients is related to improved overall and disease-free survival. Nowadays, technological support using telerehabilitation systems is a promising strategy with great advantage of a quick and efficient contact with the health professional. It is not known the role of telerehabilitation through therapeutic exercise as a support tool to implement an active lifestyle which has been shown as an effective resource to improve fitness and reduce musculoskeletal disorders of these women. METHODS / DESIGN This study will use a two-arm, assessor blinded, parallel randomized controlled trial design. People will be eligible if: their diagnosis is of stages I, II, or IIIA breast cancer; they are without chronic disease or orthopedic issues that would interfere with ability to participate in a physical activity program; they had access to the Internet and basic knowledge of computer use or living with a relative who has this knowledge; they had completed adjuvant therapy except for hormone therapy and not have a history of cancer recurrence; and they have an interest in improving lifestyle. Participants will be randomized into e-CUIDATE or usual care groups. E-CUIDATE give participants access to a range of contents: planning exercise arranged in series with breathing exercises, mobility, strength, and stretching. All of these exercises will be assigned to women in the telerehabilitation group according to perceived needs. The control group will be asked to maintain their usual routine. Study endpoints will be assessed after 8 weeks (immediate effects) and after 6 months. The primary outcome will be QoL measured by The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 version 3.0 and breast module called The European Organization for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life questionnaire. The secondary outcomes: pain (algometry, Visual Analogue Scale, Brief Pain Inventory short form); body composition; physical measurement (abdominal test, handgrip strength, back muscle strength, and multiple sit-to-stand test); cardiorespiratory fitness (International Fitness Scale, 6-minute walk test, International Physical Activity Questionnaire-Short Form); fatigue (Piper Fatigue Scale and Borg Fatigue Scale); anxiety and depression (Hospital Anxiety and Depression Scale); cognitive function (Trail Making Test and Auditory Consonant Trigram); accelerometry; lymphedema; and anthropometric perimeters. DISCUSSION This study investigates the feasibility and effectiveness of a telerehabilitation system during adjuvant treatment of patients with breast cancer. If this treatment option is effective, telehealth systems could offer a choice of supportive care to cancer patients during the survivorship phase. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01801527.

New clinical practice guideline on enteral feeding in very low birth wieght infants; second part

INTRODUCTION: The nutrition of very low birth weight (VLBW) infants is aimed at promoting a similar growth to that occurring in the uterus. However, in practice this is difficult to achieve and extrauterine growth restriction is frequent. The current tendency is to avoid this restriction by means of early parenteral and enteral nutrition. Nonetheless, uncertainty about many of the practices related with nutrition has resulted in a great variation in the way it is undertaken. In 2009 and 2011 in our hospital there was an unexpected increase in necrotizing enterocolitis. To check to see wether our nutrition policy was involved, we underlook a systematic review and drewup clinical practice guidelines (CPG) about enteral feeding in VLBW infants. New considerations about the duration of the fortification and the use of probiotics have led to an update of these CPG. METHODS: A total of 21 clinical questions were designed dealing with the type of milk, starting age, mode of administration, rate and volume of the increments, fortification, use of probiotics and protocol. Afete conducting a systematic search of the available evidence, the information was contrasted and summarized in order to draw up the recommendations. The quality of the evidence and the strength of the recommendations were determined from the SIGN scale. COMMENT: These CPG aim to help physicians in their decision making. The protocolized application of wellproven measurements reduces the variation in clinical practice and improves results.

Guía de buenas prácticas para mejorar la facturación por la asistencia sanitaria a ciudadanos de la UE en el SSPA

Esta guía ha sido elaborada y editada como parte de las actividades del proyecto de investigación “Como mejorar la recuperación de costes derivados de la asistencia sanitaria a ciudadanos de la Unión Europea en la Comunidad Autónoma de Andalucía”. Inés García-Sánchez, editora

Influencia de un programa de actividad física en niños y adolescentes obesos; evaluación del estrés fisiológico mediante compuestos en la saliva; protocolo de estudio.

Different studies4, 5 relate that stress increases in children and adolescents with overweight and obesity, and consequently their salivary physiological responses (AEA salivary alpha-amylase, cortisol, cytokines, leptin), so in this study we relate these two parameters to see their progress through a program of physical activity. If we manage to reduce overweight or obesity, these physiological responses and stress should also be reduced, thus improving the overall health status of these children and adolescents. The overall objective of the study was to determine the influence of physical activity in obese children and adolescents in perceived stress. An observational, descriptive, prospective and longitudinal study will be carried out. The universe is made up of 60 overweight / obese children and adolescents aged between 10 and 18 years. The assessment will take place from September 2012 to September 2013. To collect saliva samples, the ELISA8 method will be used. Variables such as BMI, lifestyle and diet will also be collected. Among the expected results are to lower overweight and obesity in children through physical activity program. To reduce stress and to normalize physiological salivary parameters.

Use of Two-Part Regression Calibration Model to Correct for Measurement Error in Episodically Consumed Foods in a Single-Replicate Study Design: EPIC Case Study.

In epidemiologic studies, measurement error in dietary variables often attenuates association between dietary intake and disease occurrence. To adjust for the attenuation caused by error in dietary intake, regression calibration is commonly used. To apply regression calibration, unbiased reference measurements are required. Short-term reference measurements for foods that are not consumed daily contain excess zeroes that pose challenges in the calibration model. We adapted two-part regression calibration model, initially developed for multiple replicates of reference measurements per individual to a single-replicate setting. We showed how to handle excess zero reference measurements by two-step modeling approach, how to explore heteroscedasticity in the consumed amount with variance-mean graph, how to explore nonlinearity with the generalized additive modeling (GAM) and the empirical logit approaches, and how to select covariates in the calibration model. The performance of two-part calibration model was compared with the one-part counterpart. We used vegetable intake and mortality data from European Prospective Investigation on Cancer and Nutrition (EPIC) study. In the EPIC, reference measurements were taken with 24-hour recalls. For each of the three vegetable subgroups assessed separately, correcting for error with an appropriately specified two-part calibration model resulted in about three fold increase in the strength of association with all-cause mortality, as measured by the log hazard ratio. Further found is that the standard way of including covariates in the calibration model can lead to over fitting the two-part calibration model. Moreover, the extent of adjusting for error is influenced by the number and forms of covariates in the calibration model. For episodically consumed foods, we advise researchers to pay special attention to response distribution, nonlinearity, and covariate inclusion in specifying the calibration model.

Estudis dirigits a la síntesi d'un nou compost fotocròmic amb aplicacions en recobriments protectors fotosensibles

Els compostos fotocròmics es caracteritzen per la seva capacitat d’interconvertir-se entre dos estats amb colors diferents en ser sotmesos a irradiació amb llum, motiu pel qual prenen un gran interès en la comunitat científica per les potencials aplicacions que això els confereix. Una d’aquestes aplicacions és la preparació de recobriments protectors fotosensibles que permetin regular òpticament el pas de llum a través d’ells o la reflexió de llum a la seva superfície. Aquest tipus de sistemes poden ser utilitzats com a filtres en dispositius optoelectrònics o recobriments de miralls i lents oftalmològiques. Aquest treball recull els estudis dirigits a la síntesi d’un nou potencial compost fotocròmic per a ser utilitzat en recobriments protectors fotosensibles. Per tal d’obtenir el compost objectiu, s’ha abordat una primera ruta sintètica que ha hagut d’ésser abandonada degut a la molt baixa solubilitat d’un dels intermedis i la dificultat per fer-lo reaccionar que aquest fet comporta. Seguidament s’ha ideat una segona ruta sintètica i s’ha realitzat un extens estudi sobre les condicions de reacció de l’últim pas sintètic. Malauradament, però, no s’ha aconseguit obtenir el compost objectiu.

Influencia de un programa de actividad física en niños y adolescentes obesos con apnea del sueño; protocolo de estudio.

Recent studies show an alarming increase in the rate of overweight / obesity among the infant - juvenile population. Obesity in childhood is associated with a significant number of complications, such as sleep apnea syndrome, insulin resistance and type 2 diabetes, hypertension, cardiovascular disease and some cancers. It is estimated that the prevalence of sleep apnea in children is 2-3% in the general population, while in obese adolescents, varies between 13% and 66%, according to various studies. It is associated with impairment of neurocognitive function, behavior, cardiovascular system, metabolic disorders and growth. Sleep apnea is a serious public health problem that increases when children and adolescents are overweight or obese. We hypothesize that aerobic endurance exercise can be an effective treatment for obesity and apnea at the same time. The aim of this study was to determine the influence of physical activity in children and adolescents with overweight / obesity in sleep apnea. An observational, descriptive, prospective, longitudinal study will be carried out in children with sleep apnea and obesity. The universe will be made up of 60 children and adolescents aged between 10 and 18 years, attending the endocrinology service for suffering of obesity in the Hospital Clinico San Cecilio of Granada during the period September 2012-September 2013. The smple will consist of children and adolescents that meet these characteristics and to hom their arents/tutors have authorized through the informed consent. Sleep apnea in children wil be measured by polysomnography and sleep quality questionnaire. There will also be a nutritional assessment by a food frequency questionnaire and an anthropometric assessment. Among the expected results are the lower overweight and obesity in children through the physical activity program. To reduce apnea and to improve sleep quality

Validación de dos escalas breves para evaluar la adicción a Internet

Se construyeron dos cuestionarios para evaluar el uso adictivo de Internet y del móvil que se aplicaron a una muestra de 1.879 estudiantes. Los resultados apoyan un modelo de dos factores, con una aceptable consistencia interna e indicios de validez convergente y discriminante. El Cuestionario de Experiencias Relacionadas con Internet evaluó conflictos intra e interpersonales relacionados con el uso de Internet. El Cuestionario de Experiencias Relacionadas con Móvil evaluó dos factores: primero, conflictos relacionados con el abuso del móvil, y segundo, problemas debido al uso emocional y comunicacional. Nuestros resultados indican que el móvil no produce el mismo grado de adicción; más bien se puede hablar de uso problemático. Los hombres presentaron un uso más adictivo de Internet, mientras las mujeres se caracterizaron por usar el móvil como medio para expresar y comunicar las emociones. Parece que el uso de ambas tecnologías es más problemático en la adolescencia y se normaliza con la edad, hacia un uso más profesional, menos lúdico y con menos consecuencias negativas.

Factores predictores del riesgo en los agresores violentos encarcelados

La finalidad de este estudio cuasi-experimental fue fue identificar los factores de riesgo para la reincidencia en los delitos violentos, sexuales y delitos de violencia doméstica y evaluar la eficacia del tratamiento. Se seleccionó una muestra de 120 internos del Centre Penitenciari Ponent condenados por delitos violentos, sexuales y de violencia doméstica que obtuvieron la libertad entre los años 2001 y 2006; el período de seguimiento osciló entre 3 y 8 años. Se analizaron veintisiete variables agrupadas en factores de riesgo y la reincidencia. Los datos se obtuvieron de la administración del HCR-20, de la SVR-20, de la S.A.R.A., de la PCL-R, del IPDE y del MMPI-2 y de las bases de datos del Departamento de justicia de Cataluña. Los internos con trastorno mental reincidieron más en delitos sexuales y de violencia doméstica y aquellos con trastornos de personalidad reincidieron más en delitos violentos. Una puntuación elevada en HCR-20, SVR-20, S.A.R.A. y PCL-R incrementó el riesgo de reincidencia. Al contrario, superar el tratamiento reduce la reincidencia pero presentar trastornos mentales, trastornos de personalidad, toxicomanías y puntuar alto en el HCR-20 y en la PCL-R dificultaron superar el tratamiento. A mayor período de seguimiento menor capacidad predictiva de los instrumentos de evaluación del riesgo y del tratamiento.

Two methods for voltage sag source location

This paper presents and compares two approaches to estimate the origin (upstream or downstream) of voltage sag registered in distribution substations. The first approach is based on the application of a single rule dealing with features extracted from the impedances during the fault whereas the second method exploit the variability of waveforms from an statistical point of view. Both approaches have been tested with voltage sags registered in distribution substations and advantages, drawbacks and comparative results are presented

Unusual voltage sag event detection in power systems

Three multivariate statistical tools (principal component analysis, factor analysis, analysis discriminant) have been tested to characterize and model the sags registered in distribution substations. Those models use several features to represent the magnitude, duration and unbalanced grade of sags. They have been obtained from voltage and current waveforms. The techniques are tested and compared using 69 registers of sags. The advantages and drawbacks of each technique are listed

Estimation of zero-sequence impedance of undergrounds cables for single-phase fault location in distribution systems with electric arc

This paper focus on the problem of locating single-phase faults in mixed distribution electric systems, with overhead lines and underground cables, using voltage and current measurements at the sending-end and sequence model of the network. Since calculating series impedance for underground cables is not as simple as in the case of overhead lines, the paper proposes a methodology to obtain an estimation of zero-sequence impedance of underground cables starting from previous single-faults occurred in the system, in which an electric arc occurred at the fault location. For this reason, the signal is previously pretreated to eliminate its peaks voltage and the analysis can be done working with a signal as close as a sinus wave as possible

Classification of sags according to their origin based on the waveform similarity

A statistical method for classification of sags their origin downstream or upstream from the recording point is proposed in this work. The goal is to obtain a statistical model using the sag waveforms useful to characterise one type of sags and to discriminate them from the other type. This model is built on the basis of multi-way principal component analysis an later used to project the available registers in a new space with lower dimension. Thus, a case base of diagnosed sags is built in the projection space. Finally classification is done by comparing new sags against the existing in the case base. Similarity is defined in the projection space using a combination of distances to recover the nearest neighbours to the new sag. Finally the method assigns the origin of the new sag according to the origin of their neighbours

Modelling the Human Values Scale from Consumers Transactional Data Bases

The main objective of this paper aims at developing a methodology that takes into account the human factor extracted from the data base used by the recommender systems, and which allow to resolve the specific problems of prediction and recommendation. In this work, we propose to extract the user's human values scale from the data base of the users, to improve their suitability in open environments, such as the recommender systems. For this purpose, the methodology is applied with the data of the user after interacting with the system. The methodology is exemplified with a case study

The encouragement of the open access movement: an essential realm for health information professionals in the 21st century

According to the Bethesda Statement on Open Access Policy for libraries and the recommendations of the BOAI10, libraries and librarians have an important role to fulfil in the encouragement of open access. Taking into account the Competencies for Information Professionals of the 21st Century, elaborated by the Special Libraries Association, and the Librarians’ Competencies Profile for Scholarly Publishing and Open Access, we shall identify the competencies and new areas of knowledge and expertise that have been involved in the process of the development and upkeep of our institutional repository (Repositorio SSPA).